Objective To study the clinical effect of Tianma Toutong Tablets combined with zolmitriptan in treatment of migraine.Methods A total of 80 migraine patients admitted to the Third People’s Hospital of Zhengzhou from June 2021 to June 2022 were selected as the study objects. According to the random number table method, all patients were divided into control group and treatment group, with 40 cases in each group. Patients in the control group were po administered with Zolmitriptan Tablets, 2.5 mg/time, once daily. If headache symptoms persist after the first dosage, take another 2.5 mg 2 h later and the maximum daily dosage should not exceed 15 mg. Patients in the treatment group were po administered with Tianma Toutong Tablets on the basis of the control group, 4tablets/time, 3 times daily. If symptoms do not improve well, add 1 tablet/time, each oral dosage is not more than 6 tablets, not more than 18 tablets a day. Both groups took the drug continuously for 3 months. The clinical efficacy of the two groups was observed, and the improvement of symptoms and changes of serum factors were compared between the two groups. Results After treatment, the total effective rate of the treatment group was 95.00%, which was significantly higher than that of the control group（77.50%）（P ＜0.05）. After treatment, the number of migraine attacks, duration, and visual analog scale（VAS） scores in both groups were significantly decreased compared with those before treatment（P ＜ 0.05）. After treatment, the frequency, duration and VAS score of migraine in the treatment group were lower than those in the control group（P ＜ 0.05）. After treatment, serum apolipoprotein（LPA）, tumor necrosis factor-α（TNF-α）, serum endothelin-1（ET-1）, and nitric oxide（NO） levels in two groups were significantly decreased compared with before treatment, but 5-hydroxytryptamine（5-HT） levels were significantly increased（P ＜ 0.05）. After treatment, the levels of LPA,TNF-α, ET-1 and NO in the treatment group were lower than those in the control group, but the levels of 5-HT was higher than that in the control group（P ＜ 0.05）. Conclusion Tianma Toutong Tablets combined with zolmitriptan can significantly improve the clinical symptoms of migraine patients, and can regulate the level of serum factors, and does not increase the incidence of adverse reactions,which has a certain clinical application value.

目的 探讨呼吸暂停低通气指数(AHI)对急性缺血性脑卒中(AIS)预后的预测价值.方法 纳入2018年1月～2022年2月郑州市第三人民医院神经内科收治的AIS患者193例,根据随访3个月改良的Rankin量表(mRS)评分分为预后良好组(mRS评分≤2分)121例和预后不良组(mRS评分>2分)72例,对比2组间AHI、入院时美国国立卫生研究院卒中量表评分等差异.采用ROC曲线分析AHI对AIS发病后3个月预后的预测作用.结果 预后不良组年龄和AHI明显高于预后良好组(P<0.05,P<0.01).年龄(OR=1.108,95％CI:1.031～1.190,P=0.005),AHI(OR=1.060,95％CI:1.018～1.103,P=0.004)是AIS发病3个月预后不良的危险因素.用于预测AIS发病后3个月预后不良的AHI最佳截断值为19.2次/h,ROC曲线下面积为0.640(95％CI:0.536～0.745,P=0.012).结论 AHI是AIS发病后3个月预后的独立预测因子,AHI升高提示患者预后不良.

Objective To explore the clinical effect of traditional Chinese acupuncture rehabilitation therapy on stroke patients with limb dysfunction. Methods 84 stroke patients with limb dysfunction were randomly divided into two groups. The control group was given routine rehabilitation therapy, and the observation group was given traditional Chinese acupuncture rehabilitation therapy on this basis. The neurological function（NIHSS score）, limb motor function（upper and lower limb motor function scores） and ability of daily living（ADL score） of the two groups were compared. Results After treatment, the NIHSS score of the observation group was lower than that of the control group, and the limb motor function and ADL scores were higher than those of the control group（P ＜0.05）. Conclusions Traditional Chinese acupuncture rehabilitation therapy has better application effect on stroke patients with limb dysfunction, which has positive effect in improving patients’ neurological function, limb motor function and quality of life.

目的 探讨间歇低氧大鼠淋巴细胞促进脑血管内皮细胞内质网应激凋亡作用及机制.方法 取SD雄性大鼠30只,分为正常对照组、间歇低氧组、抗低氧组,每组各10只;抗低氧组、间歇低氧组建立间歇低氧大鼠模型,并分别于间歇低氧前半小时腹腔注射100 mg/kg超氧阴离子清除剂和等量生理盐水,1次/d,然后间歇低氧干预8 h/d;正常对照组维持常氧量,干预6周;各组干预后分离淋巴细胞,测定CD4+、CD8+T细胞凋亡率;取对数期内皮细胞RBE4,与各组分离淋巴细胞共培养,命名为正常对照RBE4组、间歇低氧RBE4组、抗低氧RBE4组;4 h后测定培养基上清液中超氧化物歧化酶(Superoxide dismutase,SOD)及丙二醛(Malonaldehyde,MDA)水平、内皮细胞凋亡率、内皮细胞中C增强子结合蛋白同源蛋白(Cenhancer binding protein homologous protein,CHOP)、葡萄糖调节蛋白78(Glucose regulatory protein 78,GRP78)、半胱氨酸天冬氨酸蛋白水解酶-3(Cysteine containing aspartate-specific proteases-3,Caspase-3)mRNA及蛋白水平.结果 与正常对照组比较,间歇低氧组、抗低氧组CD4+、CD8+T细胞凋亡率降低,且间歇低氧组低于抗低氧组(P<0.05);与正常对照RBE4组比较,间歇低氧RBE4组、抗低氧RBE4组上清液中SOD水平降低、MDA水平增高、RBE4凋亡率增高、CHOP,Caspase-3 mRNA及蛋白水平升高、GRP78 mRNA及蛋白水平降低(P均<0.05);与抗低氧RBE4组比较,间歇低氧组SOD水平降低、MDA水平增高、RBE4凋亡率增高、CHOP,Caspase-3 mRNA及蛋白水平升高、GRP78 mRNA及蛋白水平降低(P均<0.05).结论 间歇低氧大鼠淋巴细胞促进脑血管内皮细胞凋亡可能通过激发内质网应激而发挥作用.

目的 探讨阻塞型睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)对急性缺血性卒中患者脑血管反应性(cerebrovascular reactivity,CVR)的影响.方法 前瞻性连续入组2017年10月-2020年8月住院治疗的急性缺血性卒中患者,入院2周内完善多导睡眠监测,根据是否合并OSAHS及呼吸暂停低通气指数(apnea hypopnea index,AHI)将患者分为非OSAHS组、轻度OSAHS组(AHI 5～15次/小时)和中重度OSAHS组(AHI>15次/小时).在完成多导睡眠监测后24?h内对患者进行TCD检查,检测CVR指标包括平静呼吸时、屏气后大脑中动脉的平均血流速度(Vm),计算屏气指数(breath holding index,BHI).比较三组间CVR指标的差异,并在中重度OSAHS组中分析CVR指标与入院时和发病3个月时NIHSS评分的相关性.结果 共纳入228例急性缺血性卒中患者,男性140例(61.4％),其中非OSAHS组49例,轻度OSAHS组42例,中重度OSAHS组137例.中重度OSAHS组BMI、高血压比例、3个月时NIHSS评分均高于非OSAHS组,差异有统计学意义.中重度OSAHS组平静呼吸时Vm低于非OSAHS组(57.4±10.6?cm/s?vs?62.1±12.2 cm/s,P=0.010)和轻度OSAHS组(57.4±10.6?cm/s?vs?59.6±11.2?cm/s,P=0.007),BHI低于非OSAHS组(1.4％±0.6％?vs?1.7％±0.7％,P=0.002)和轻度OSAHS组(1.4％±0.6％?vs?1.5％±0.6％,P=0.001).中重度OSAHS组发病3个月时NIHSS评分与平静呼吸时Vm(r=-0.696,P<0.001)和BHI(r=-0.832,P<0.001)呈负相关.结论 伴中重度OSAHS的急性缺血性卒中患者CVR明显下降,而且CVR的下降可能与急性缺血性卒中患者的预后不良有关.

目的:研究小GTP结合蛋白(Rho)/Rho相关卷曲螺旋形成蛋白激酶(ROCK)信号通路在阻塞性睡眠呼吸暂停低通气综合征(OSAHS)大鼠急性缺血性卒中发生中的作用,为OSAHS后急性缺血性卒中病变的防治提供参考.方法:50只SD大鼠随机分为假手术组、OSAHS组、卒中组、OSAHS后卒中组和Rho抑制剂组(C3转移酶5μg·kg-1·d-1腹腔注射),每组10只.采用慢性间歇性低氧建立OSAHS模型,线栓法阻断大脑中动脉建立急性脑卒中模型.观察各组大鼠建模后的一般情况和脑皮质区组织病理形态表现,计算脑梗死体积.比较各组大鼠呼吸频率和神经功能损伤评分,采用实时荧光定量PCR(RT-qPCR)法和Western blotting法检测各组大鼠脑组织中肌球蛋白轻链(MLC)、Rho和ROCK mRNA及蛋白表达水平.结果:与假手术组比较,其他各组大鼠均有精神状态不佳和脑皮层结构损伤等改变,其中OSAHS后卒中组大鼠变化最严重,Rho抑制剂组变化较轻.与假手术组比较,OSAHS组大鼠呼吸频率增加(P<0.05);与OSAHS组比较,卒中组大鼠呼吸频率降低(P<0.05);与卒中组比较,OSAHS后卒中组大鼠呼吸频率和Longa评分增加(P<0.05),Rho抑制剂组大鼠Longa评分降低(P<0.05);与OSAHS后卒中组比较,Rho抑制剂组大鼠呼吸频率与和Longa评分均降低(P<0.05).与假手术组比较,OSAHS组大鼠逃避潜伏期延长(P<0.05),穿越平台次数减少(P<0.05);与OSAHS组比较,卒中组大鼠逃避潜伏期延长(P<0.05),穿越平台次数减少(P<0.05);与卒中组比较,OSAHS后卒中组大鼠逃避潜伏期延长(P<0.05),穿越平台次数减少(P<0.05);与OSAHS后卒中组比较,Rho抑制剂组大鼠逃避潜伏期缩短(P<0.05),穿越平台次数增加(P<0.05).与卒中组比较,OSAHS后卒中组大鼠脑梗死体积增大(P<0.05);与OSAHS后卒中组比较,Rho抑制剂组大鼠脑梗死体积缩小(P<0.05).与假手术组比较,OSAHS组大鼠脑组织中Rho和ROCK mRNA和蛋白表达水平及p-MLC/MLC比值升高(P<0.05);与OSAHS组比较,卒中组大鼠脑组织中Rho和ROCK mRNA及蛋白表达水平及其p-MLC/MLC比值升高(P<0.05);与卒中组比较,OSAHS后卒中组大鼠脑组织中Rho和ROCK mRNA及蛋白相表达水平及其p-MLC/MLC比值升高(P<0.05);与OSAHS后卒中组比较,Rho抑制剂组大鼠脑组织中Rho和ROCK mRNA及蛋白表达水平及其p-MLC/MLC比值降低(P<0.05).结论:OSAHS的间歇性缺氧状态可损伤神经功能,Rho/ROCK信号通路可能在OSAHS大鼠急性缺血性卒中发生中起一定作用.

目的 探讨脑出血患者(ICH)的阻塞性睡眠呼吸暂停低通气综合征(OSAHS)相关危险因素.方法 纳入2017年3月-2020年12月郑州市第三人民医院神经内科收治的急性脑出血患者53例,根据呼吸暂停低通气指数(AHI)分为对照组36例(不存在或轻中度OSAHS)(AHI＜ 30次/h)及重度OSAHS组17例(AHI≥30次/h).对比两组患者的一般资料、血管危险因素、美国国立卫生研究院卒中量表(NIHSS)评分、格拉斯哥昏迷评分(GCS)、构音障碍及吞咽困难的差异,并进一步通过多因素Logistic回归分析与重度OSAHS相关的危险因素.结果 与对照组相比,重度OSAHS组的BMI较大(P =0.000),构音障碍(P=0.029)、吞咽困难(P=0.018)的患病率明显较高,其指标未见统计学差异(均P＞0.05);对BMI、构音障碍、吞咽困难进行多因素Logistic回归分析,结果显示BMI(OR=1.813,95％ CI:1.303～2.5240,P=0.001)、吞咽困难(OR =0.246,95％ CI:0.067～0.903,P=0.034)是重度OSAHS组的独立危险因素.结论 BMI及吞咽困难是脑出血患者的重度OSAHS的独立危险因素.

目的 探讨觉醒型脑卒中(WUS)与阻塞性睡眠呼吸暂停综合征(OSAS)之间的关系.方法 纳入147例急性缺血性脑卒中患者,根据发病时间分为WUS组43例及非觉醒型脑卒中(NWUS)组104例,患者均行多导睡眠监测,用二元logistic回归分析危险因素.结果 WUS组中重度OSAS比例(62.8％vs 39.4％,P=0.011),呼吸暂停低通气指数[AHI,24.7(5.9,45.1)次/h vs 12.7(5.3,32.9)次/h,P=0.031]和 LDL 水平明显高于 NWUS 组(P＜0.05).二元 logistic 回归分析显示,中重度OSAS(OR=3.099,95％CI:1.628～15.288,P=0.011)、AHI(OR=1.371,95％CI:1.203～1.561,P=0.007)是WUS的独立危险因素.结论 WUS患者中重度OSAS发生率高,且中重度OSAS是WUS的独立危险因素.

目的 探讨脂蛋白相关磷脂酶A2(Lp-PLA2)对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者伴缺血性脑血管病(ICVD)的预测作用.方法 回顾性分析93例OSAHS患者的临床资料,根据其是否患有ICVD,分为OSAHS伴ICVD组(38例)和OSAHS不伴ICVD组(55例).比较2组人口统计学资料、血管危险因素、Lp-PLA2水平的差异,并通过二元logistic回归分析和受试者工作特征曲线(ROC)分析Lp-PLA2对OSAHS患者伴ICVD的预测作用.结果 (1)与OSAHS不伴ICVD组相比,OSAHS伴ICVD组的年龄较大,呼吸暂停-低通气指数(AHI)、氧饱和度指数(ODI)及Lp-PLA2水平较高,高血压病的患病率较高(P<0.05).(2)logistic回归分析发现年龄越小、AHI越低是OSAHS患者合并ICVD的保护因素,Lp-PLA2升高是OSAHS患者伴ICVD的危险因素.(3)Lp-PLA2预测OSAHS患者伴ICVD的ROC曲线下面积为0.805(95％CI:0.710～0.880,P<0.001),Lp-PLA2最佳预测值为257.39 ng/mL(敏感度86.8％,特异度67.3％).结论 Lp-PLA2与OSAHS患者ICVD的发生有关,升高的Lp-PLA2水平可能对OSAHS患者伴ICVD具有一定的预测价值.

Objective: To study the MRI and CT characteristics of different periods of acute ischemic stroke and evaluate its diagnostic value by using semi-automatic mention segmentation method. Methods: CT, conventional MRI and DWI were performed in 64 patients with acute ischemic stroke. The average ADC value and average relative ADC (rADC) value of infarct lesions were measured and statistically analyzed. Results: There were no significant differences in CT, conventional MRI, and DWI signal characteristics between 1 and 7 days after the onset of acute ischemic stroke. The average ADC value and the average rADC value decreased, but the average rADC in the infarct area increased with time. The rADC value was statistically significant with the onset of 1d, 2d, 3d, and 4d (P < 0.05), but not statistically significant with the onset of 5d and 6d (P > 0.05). Conclusion: In the image processing method of semi-automatic segmentation method, the characteristics of CT, conventional MRI, and DWI signals combined with the evolution of rADC values over time can help to judge the pathophysiological changes of acute ischemic stroke, which is ischemic. Stroke staging and treatment guidance are provided.

目的 探讨抗接触蛋白相关蛋白-2(CASPR2)抗体相关自身免疫性脑炎的临床特征及治疗.方法 选取2017年3月至2020年12月在郑州市第三人民医院和河南中医药大学第一附属医院确诊的5例抗CASPR2抗体相关自身免疫性脑炎患者临床资料进行回顾性分析.结果 5例患者中男3例,1例患者发病前有发热病史,2例表现为精神行为异常、2例患者以癫痫为首发症状、1例患者表现为记忆力下降,合并神经疼痛基础上存在失眠者1例、合并小脑症状同时存在失眠者1例,合并自主神经功能障碍者2例.5例患者血清抗CASPR2抗体均为阳性,1例患者脑脊液抗CASPR2抗体呈阳性,所有患者均接受免疫治疗,治疗有效.结论 抗CASPR2抗体相关自身免疫性脑炎可累及中枢神经系统、外周神经系统、自主神经系统等多系统从而引起多变临床综合征,免疫治疗有效.

目的 探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)与急性缺血性脑卒中预后的关系.方法 连续收集2018年1月～2020年1月郑州市第三人民医院及郑州市第二人民医院神经内科收治的急性缺血性脑卒中患者91例,根据呼吸暂停低通气指数(AHI)分为单纯脑梗死组33例(AHI<5/h),轻度OSAHS组18例(AHI 5～14/h)及中重度OSAHS组40例(AHI≥15/h).对比3组一般资料、血管危险因素、美国国立卫生研究院卒中量表(NIHSS)评分、Barthel指数及改良的Rankin量表(mRS)评分的差异.随访脑卒中发病后3个月,3组Barthel指数及mRS评分的差异.结果 3组性别、年龄、BMI、颈围、糖尿病、冠心病、高脂血症、心房颤动和NIHSS评分比较,差异无统计学意义(P>0.05).单纯脑梗死组、轻度OSAHS组和中重度OSAHS组高血压患病率比较,差异有统计学意义(48.5％ vs 61.1％ vs 77.5％,P=0.036).3组入院当天Barthel指数及mRS评分比较,差异无统计学意义(P>0.05);3组发病后3个月Barthel指数和mRS评分比较,差异有统计学意义(P<0.01).中重度OSAHS组发病后3个月Barthel指数明显低于单纯脑梗死组[(77.0±7.1)分vs(85.3±7.2)分,P<0.05],mRS评分明显高于单纯脑梗死组[(2.2±0.8)分vs(1.3±0.8)分,P<0.05].结论 中重度OSAHS与急性缺血性脑卒中预后不良结局有关.

目的 探讨急性缺血性卒中患者阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)与相关血液生化标志物的关系.方法 纳入2018年1月-2019年12月郑州市第三人民医院及郑州市第二人民医院收治的急性缺血性卒中患者,根据多导睡眠图检测结果分为缺血性卒中伴OSAHS组和单纯缺血性卒中组,对比两组间一般资料、hs-CRP、D-二聚体(D-dimer,D-D)及纤维蛋白原降解产物(fibrinogen degradation products,FDP)的差异.根据OSAHS严重程度,分为轻度OSAHS组,中度OSAHS组,重度OSAHS组,并比较3组患者hs-CRP、D-D及FDP的差异.结果 共纳入98例患者,其中缺血性卒中伴OSAHS组59例,单纯缺血性卒中组39例;缺血性卒中伴OSAHS组中轻度OSAHS 19例,中度OSAHS 16例,重度OSAHS 24例.缺血性卒中伴OSAHS组的BMI (26.33±4.16 kg/m2 vs 23.93±3.83 kg/m2,P=0.048)、hs-CRP (11.95±3.11 mg/Lvs6.13±1.69mg/L,P＜0.001)、D-D[0.78 (0.38～1.21) mg/Lvs 0.25 (0.14～0.30) mg/L,P＜0.001]、FDP(3.36±1.39 μg/mL vs2.30±0.88 μg/mL,P=0.005)均高于单纯缺血性卒中组.轻度OSAHS组(7.92±2.15 mg/L,P＜0.001)和中度OSAHS组(11.47±2.54 mg/L,P=0.005) hs-CRP水平均低于重度OSAHS组(15.31±3.16 mg/L),轻度OSAHS组hs-CRP水平低于中度OSAHS组(P=0.012).轻度OSAHS组D-D水平低于重度OSAHS组[0.42 (0.23～0.98) mg/Lvs0.98 (0.93～1.85) mg/L,P=0.023],轻度OSAHS组FDP水平低于重度OSAHS组(2.74±0.93 μg/mL vs4.19±1.55 μg/mL,P=0.012).结论 与不伴OSAHS的急性缺血性卒中患者相比,伴有OSAHS的急性缺血性卒中患者血清hs-CRP、D-D、FDP水平更高.